6 states to watch on health reform

Health reform repeal efforts will generate a lot of noise in the opening weeks of the 112th Congress – but the real action on health reform is going to ramp up outside the Beltway in state capitals.

“Unless states move forward as fast and as hard as they can this year, they will be lost in 2014 when the bulk of health reform hits,” says Stan Dorn, a senior health policy researcher at the Urban Institute. “The pressure is just enormous on state policy makers.”

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In Washington, House Republican attempts to repeal the reform law are likely to die in the Senate – or, failing that – at President Obama’s veto. Meanwhile, state legislatures, whether they are dominated by Democrats or Republicans, must brace for a frenetic and fast-paced year of building the infrastructure needed for reform.

Thirty-three states have created some entity to implement the new federal health law and over a dozen require a report on the law by the early part of 2011, according to the National Conference of State Legislatures.

All 50 states will take some action on the health reform law in the coming year. Here are six to watch closely in early 2011:

Wisconsin – The Badger State has aggressively lead the way on health exchanges, developing an online prototype that Wisconsinites can already take for a spin. In late December, Wisconsin applied for an “early innovator” grant, which would mean increased federal funding and serve as a model for others. But Wisconsin’s assembly, senate, and governorship all flipped from Democratic to Republican control in November. Republican Governor Scott Walker, who takes office today, won’t take a firm line against pursuing health reform grants—but he has also promised to “back off” of a lot of the state has done so far, moving the work in a different direction.

“I don’t want to put anything in place that forces us into mandates of what kind of coverage needs to be provided,” Walker told POLITICO. “The concept of an exchange itself is not something I’m against…a system where there’s a defined component to what has to be in the exchange. That to me is where the problem is.”

Walker will, however, remain open to pursuing Health and Human Services grants and working with Secretary Kathleen Sebelius. “I’d like to think we can be an innovator as well, but from a much different point of view from what Governor Doyle was doing,” Walker says, noting that he does not plan to withdraw the state’s early innovator application.

Within days of his election, Walker began aggressively opposing Wisconsin’s work on health reform. In a November 12 letter to the state’s Department of Administration, he requested they “temporarily freeze any new implementation of the federal health reform law” until after he took office. The same day, Walker announced he would allow Republican attorney general J.B. Van Hollen to join an anti-health reform lawsuit. Walker’s Democratic predecessor had barred Holland from doing so.

Vermont – Newly sworn-in Democratic Governor Peter Shumlin ran on an aggressive, single-payer platform. Now, all eyes watch Vermont to see whether it’s possible to turn the single payer promise into policy—and whether it can be implemented in tandem with the reform law.

“There’s a lot we can do under the existing law, but also some clear limitations,” says Anya Rader Wallack, health policy advisor to the governor. “We will try and do the maximum we can under the existing law…and I think seek federal permission for flexibility.”